Business

Nursing Success

It is perhaps the most unusual immigration story out of India: thousands and thousands of females – married or single – migrating alone to America, braving a new country, loneliness and a challenging new job without the support of family or friends. Often the primary breadwinner of the family, they start out on a new continent, put down roots and then begin sending for family members.

Mandeep Dewal: “For a woman and a mother, nursing is a very flexible job: you can work three different shifts and three days versus five days

With their qualifications they secure green cards not only for their spouses and children, but over time for siblings and parents as well, opening the door of possibilities for the entire extended family, and sometimes end up making a six figure salary themselves.

All with a nursing certificate, their open sesame to America.

Indian nurses are the largest block of international nurses after Filipinos in the United States. A 2000 survey found that Indians constitute 10 percent of all foreign nurses in the United States, but that number declined to just 1.3% in a 2004 survey. But the nurse migration from India has picked up steam. In 2006, 4,395 Indian nurses sat for the NCLEX nursing exam, a number that has almost doubled in two years.

In the past, the immigration process for Indian nurses was cumbersome, as they had to pass their licensing exam in the United States before they could seek jobs. But now the National Council of State Board of Nursing has established five centers in Bombay, Hyderabad, Bangalore, Chennai and Delhi – more than any other country in the world. It is testimony to where the profession is headed for the new crop of nurses in the years ahead.

The Indian nurses have come to the rescue of the American medical system weighted by an acute shortage of nurses and in the process they have built success and prosperity for their families as well. While nurses are now drawn from all parts of India, Malayalee nurses form by far the single largest contingent, making it the largest mass migration from Kerala to America.

Aney Paul is one of these Malayalee nurses from Kerala. Nothing much ever happened in her hometown and dreams remained idle dreams there. Paul left India 25 years ago with a nursing degree and today she has a beautiful home in Westchester County in New York, her husband works with the city and their three children have succeeded beyond any dreams dreamt in her home town. Her daughter has a Ph.D. from Princeton University, another graduated from New York University and her son is pursuing pre-med at the State University of New York, Albany. Paul herself has a master’s in nursing and public health and is just taking the exam for nurse practitioner, which can lead to a paycheck of over $100,000.

Ann Varghese:Nursing here and in India is totally different. I’m sure it’s changed there too now, but in those days there was a big difference in the relationships between the nurse and the patients and how you interact, and the educational process here you really educate the patient before you do anything for them, which we were very unaccustomed to in India.”

A typical rags to riches American success story you say? Well, this one has the twist of woman power, of a wife and mother who takes destiny into her own hands and makes the family’s future.

Laban Pattanaik, co-director of RN India Inc., a nurse recruiting agency based on the West coast, estimates that there will be a major upsurge in Indian nurses migrating to the United States next year, because of the enormous increase in the number of candidates taking exams in India.

RN India was started in 2003 in California and is one of several agencies bringing Indian nurses into the country. The organization has sponsored 150 nurses and plans on bringing 300-350 next year, as there was an immigration backlog of about six months. Says Pattanaik, “It is growing tremendously and we now have offices in Cochin, Delhi, Mumbai, Ludhiana and Pune.”

Most nurses come under the employment based third preference green card – EB3 visa – but because of the severe shortage of nurses, the US government has carved out a special category Schedule A, which exempts nurses and physical therapists from the labor certification process, enabling them to get their immigrant visa and green cards approved within 7 or 8 months, not just for themselves, but for their spouses and children as well.

Nursing, once regarded as a lowly profession in India, has gained cache and “nurse brides” are much in demand on matrimonial sites, such as Tamilmatrimony.com. A nursing degree is now a ticket out of the country, a door through which an entire family can get a green card to America and a readymade lifestyle – no waiting required.

With the aging of the population and an acute shortage of nurses in the United States, the demand is only destined to grow. The expected shortage of nurses in the next decade is estimated at between half million to a million, according to several studies. According to Pattanaik, in 2005 the quota was raised for India, China and the Philippines and Congress allocated a special category for nurses and physical therapists.

He says, “There has been lot of active lobbying happening with the American Hospital Association, immigration attorneys and groups like ourselves. There is a huge lobbying effort to exempt nurses, physical therapists and other Schedule A workers from any numerical limitation, so there’s a high degree of confidence that this will happen over the course of the next six months.”

The human resources director from Good Samaritan Hospital Los Angeles meets with candidates and RN India’s principal’s Lalit and Laban Pattanaik in Kochi

Little wonder then that scores of nursing schools are mushrooming across India, and nursing has become a very lucrative career. Sara Gabriel, based in Chicago, is the president of the National Association of Indian Nurses in America (NAINA). She says that even males are trying to get into the nursing field and in Kerala, nursing is the next most popular profession after medicine.

But why India and why Kerala?

India of course has a large migrant community and its strength in numbers, job applicants and English speaking ability has made people its largest export. For several decades now, since the 1950s and 1960s nursing was a popular woman’s profession in Kerala, more than any other state. It is the most literate and largely English speaking state with a large population of Christians who have familiarity with service oriented professions.

“Teaching and nursing for the women was the model followed in Kerala, because of the missionary activity and Christianity,” says Aney Paul, who heads the New York chapter of Indian Nurses Association and is a nurse in Nyack in Westchester: “These professions were deemed to be quite noble where the nurses are taking care of the community.”

Ravindra Dhillon: I consider it a very good profession. You have job stability, you are serving people and you get satisfaction in your job that you did something good.”

Yet this was not always the attitude with many families in Kerala. Ammal Bernard, who hails from the small village of Kottayam in Kerala and now lives in Miami, Fl., recalls that she was the first woman to go into nursing in her family and her village and was almost treated as if she was committing a crime!

“I was practically driven out of my home. They threatened me that if I go into nursing they wouldn’t take me back. That time it was very, very hard for a girl to leave her home to take a job to go to the city or out of country.”

Since childhood she had been an avid reader and a book she read on Florence Nightingale convinced her that she would like to do that kind of work. Finally her brother, who was in the air force and stationed in Jodhpur, supported her decision and arranged for her to join a nursing school there. After completing her training she became a nurse in India. Then a friend from her neighborhood who had migrated to the US helped her to apply for a position in New York.

With a sponsorship and job offer in hand, she landed in 1971 at Montfiore Medical Center, a huge city hospital in the hurly-burly of the Bronx, a continent and light years away from sleepy Kottayam. At that time there were few Malayalees, she recalls. She was picked up at JFK by two nurses – a Malayalee and a Tamilian – and deposited in an apartment. The two then left for their night shift duties at the hospital, and Barnard spent her first night alone in a new, alien place. She says, “It was a scary feeling. Everything was new to me. But it was also exciting and I survived.”

Bernard worked at Montfiore for over 11 years and fell into the rhythm of things. Nursing, the career her family and village had disapproved of, not only brought her to Americ,a but even found her a suitable husband – a Malayalee from Canada, in an arranged match through friends.

The perception of nursing has totally transformed in India.

Ammal Barnard: Everybody says it’s all because of me. I was focusing hundred percent on the family and I did it all for the family and I achieved that part very well. Even the people in my village are happy with what I did.”

“Now I believe after medicine, in the health care field, nursing is the second best profession they are looking for, especially in Kerala,” says Sara Gabriel. “There are non-Christians also going in for nursing. Right now what I’m hearing is that in Kerala people from all walks of life, rich people, male nurses, they are all in queue and they cannot get into nursing school. It’s very difficult to get in, even though there are many more schools.”

She adds, “There is a lot of job security in nursing and overseas nurses have helped the economy in Kerala in a big way by their remittances home. Besides Kerala, there are other states in the same path where lots of people are going for nursing.”

Says Pattanaik: “We’ve had nurses whose mothers were nurses and their grandmothers were nurses and lots of those people have gone to the Gulf or to the UK and now that this US opportunity has opened, it is the ultimate destination for nurses. I think the Malayalees have been used to the migration pattern of going to another country to really leverage the skills set and experience that they have as nurses.”

The financial rewards are substantial: In India annual salaries for nurses range from Rs. $1,500 to $3,000, but in the U.S. salaries average $57,000, varying on geography and hospital. Says Patanaik, “Typically what’s happening for many of our nurses is that $60,000 salary is basically equating to working 3 days a week; They have 12 hour shifts but most of them are so used to working longer hours than that that they are putting in one or two extra shifts a week and then typically the salaries are going up to $70,000-75,000, because they are paid overtime wages in many cases.”

Sara Gabriel: a lot of nurses who came alone, leaving their families and children had to sacrifice their personal lives to make a living in the 70’s.

As the numbers of Indian nurses has exploded in the country, many associations of Indian nurses have formed with the ones in New Jersey, Houston, Dallas and Miami functioning for over a decade now. This year all of them came together under one umbrella, the National Association of Indian Nurses of America (NAINA).

Some of the nurses who joined 30 years ago have seen a sea change in their profession both in India and in America. In India many of them did not even learn typing and here everything in the hospital system is computerized from electronic monitoring of patients to ordering charts. So for many it was a new learning experience.

The respect nurses receive in the US adds to its allure of Indians. Aney Paul recalls that in India nurses were treated like the handmaidens of the doctors, doing everything for them, from pulling a chair for them. She says, “Here the doctors are the captains of the ship and are responsible for the welfare of the patient, but they are team leaders and every other member in the team is equally important. Nurses are one of the most important key members in the hospital setting.

“They have much higher respect in this society. If you are educated, qualified and capable, you are billed as a peer among the senior team members and when the young people see this they also want to go into nursing, just like they go into medical school or pharmacy school. It’s a big plus.”

Today, Indian nurses are everywhere, from small towns to big cities, in nursing homes, private offices and big county hospitals. Ann Varghese, who works at a major city hospital in Dallas, came from the town of Patthanamthitta in Kerala. “Right out of school, I became a nurse. I’ve been a nurse for over 30-35 years and in those days it was not a popular profession. Actually my older sister went into nursing first and she kind of inspired me.”

Preparing for the nursing exam in India

She followed her sister and sister-in-law, both nurses, who were already in the US and worked in the Tolstoy Nursing Home in Rockland County, NY for four and a half years. Today she works at the Parkland Hospital System in Dallas – a large state and teaching hospital, which has over 1,700 nurses, several hundred of whom are Indian.

Did she have to make any adjustments in her career? She says, “Yes, I did. Nursing here and in India is totally different. I’m sure it’s changed there too now, but in those days there was a big difference in the relationships between the nurse and the patients and how you interact, and the educational process here you really educate the patient before you do anything for them, which we were very unaccustomed to in India.”

She recalls it was a bigger adjustment for her husband who had earlier worked in the Middle East. They moved to Dallas so he could get an appropriate job and took shifts so one parent could always be with the children. Would her life have been very different if the family had never immigrated? Varghese feels that nursing is a lucrative profession even in India, but the US offers so much more for the future of their children, since education and jobs are harder to find in India.

Sara Gabriel, who came in 1973, started out on regular work visa with her husband. A graduate of Christian Medical College in Vellore,Tamil Nadu, she studied for her masters in nursing from Layola College, Chicago. Starting out as a staff nurse, she has worked in administration and education. She is currently a nurse administrator at John Stroger Hospital in Chicago, a big city hospital, and has worked at six different area hospitals.

“I did not go through the struggles many nurses went through, because my husband was already here and working,” she says. “But a lot of nurses who came alone, leaving their families and children had to sacrifice their personal lives to make a living in the 70’s. They had to pass the exams here and also send money to support their families back home. There are a lot of stories like that.

“In a lot of families the first daughter went to nursing school and came over here, and slowly brought the siblings here and settled down in good places and sent money back to their parents.”

By contrast the nurses coming now through the recruiting agencies take their exams and English proficiency tests in India and come on a contract with a hospital. After working the required years, they are free to go wherever they like.

Not surprisingly nursing is developing appeal in all parts of India.

“There’s no question about it, that’s why we’ve opened up offices in Punjab because the people there have a lot of relatives in the UK and Canada or the US and they see that nursing is an opportunity to come to the West,” says Pattanaik. “It’s an excellent profession, but it’s also a green card opportunity so people are seeing this as a viable way to make a life for themselves and their families.”

Ravindra Dhillon is a Punjabi who has been in nursing for many years and has practiced in hospitals not only in India and the US. but also in Iran and Libya. Dhillon, who currently is a nurse educator in the VA Hospital in St. Albans, Queens, in New York, says: “In India itself a lot of North Indian women are opting to go in for nursing. The trends are changing in India too and it’s not only the women from the South who are going in for nursing. I consider it a very good profession. You have job stability, you are serving people and you get satisfaction in your job that you did something good.”

Her story is also about the difficulties and adjustments nurses have to make. In India she was director of nursing at Luthra Heart Institute, but in the US she had to start from the bottom rung as a licensed practical nurse gradually rising to registered nurse, and then obtaining advanced nurising degrees. The struggle was worth it. Today as a nurse educator with the federal government she makes a salary of $100,000 and has tremendous satisfaction in her challenging job.

Now second generation Indian Americans are also seeing it as a very viable job. Mandeep Dewal, who came to the US at age 11 and is a niece of Dhillon, has embraced the career. She has a number of nurses in her family and went into nursing after high school. Her first job as an RN was at Northshore Hospital in Long Island, NY.

“For a woman and a mother, nursing is a very flexible job: you can work three different shifts and three days versus five days,” says Dewal, who works in the Little Neck Nursing Home in Queens. “If you ask me, I’d recommend this to any woman who has kids at home. I’m home four days with my child, and I’m working three days, but it’s considered a full time job because I’m doing 12 hour shifts.”

New Indian nurses at their orientation at the Good Samaritan Hospital, Los Angeles

Nursing even offers opportunities to work largely from home, such as hospice nursing for terminally ill patients, where the nurse monitors their needs largely with phone communications and some visits.

The job does carry a lot of responsibility and is stressful. Says Deval, “The nursing homes are a little bit laid back, compared to the hospitals, but the responsibility is the same. It’s just a fast track and the slow track but you’re still responsible.”

Varghese has worked in big hospitals and shares her insights of places which readers only get to see when they are sick or on ‘ER’ on television. She says, “It’s a wonderful experience. I’ve spent 25 years there and worked five or six years in every area. Every day is a learning process. Right now I’m working in the outpatient clinic and that’s a totally different experience than bedside nursing, which I did for 15 years. And I enjoyed that too a lot, because every time you help a person you feel you gave something and that’s a good feeling.”

She cautions, “It’s not an easy job and nursing is not for everybody. You have to have that feeling within you, that compassion, the caring attitude has to be there in order for you to be a nurse and enjoy it. Yes there are financial rewards, but if that’s the only reason you’re going into it, then you are not going to enjoy nursing.”

Says Varghese: “You’re dealing with all kinds of people, some are very appreciative, some can be very demanding and also there are those who don’t really know how to interact with people. You have to handle difficult situations.”

So what makes it all worthwhile? She says, “I’ve had cancer patients that I used to give chemotherapy to and I remember a young cop who used to come for therapy. He seemed to be at the bottom of his life, but gradually after courses of chemotherapy he gradually was doing very well, becoming free of cancer – and walking out of there, hugging us all. Those kind of memories stick.”

The Indian nurses are now seeking to organize to promote their welfare by helping them tap opportunities for internships, financial fellowships for studies and grants for research.

Some of the stories of the nurses start in Indian villages, towns and cities and end in America with a most Bollywood-like happy ending. Take the case of Ammal Bernard, who is joint secretary of NAINA and a well-established nurse in Miami who has headed the association of nurses there for many years. She is a nurse at the Coral Reef Nursing and Rehab Center and has been a mentor to many nurses from India.

She’s also the woman whose family in Kerala had almost disowned her when she first decided to become a nurse and set out for America.

She ended up transforming the lives of all her family members and their unborn children. After she came to the US she got her three brothers and three sisters and even her father American citizenship. They all had success in America. Today she has 17 nephews and nieces, all of them doctors, nurses or engineers and one of them is a Ph.D in pharmacy.

It all started with the seed of her becoming a nurse and setting out for America.

So she made her family’s fortune? She smiles and says with satisfaction, “Yes I did. That is why all my family members come together in Miami whenever they get time – we are very attached and family people. Everybody says it’s all because of me. I was focusing hundred percent on the family and I did it all for the family and I achieved that part very well. Even the people in my village are happy with what I did.”

Her story is multiplied many times over as thousands of Indian nurses migrate all over the world and create their own stories of service and success.